Prognostic value of three-dimensional echocardiographic right ventricular ejection fraction in patients with pulmonary arterial hypertension

Abstract

BackgroundRight ventricular (RV) function is an independent predictor of clinical outcomes in patients with pulmonary arterial hypertension (PAH). However, it remains controversial which RV parameter should be measured as an appropriate index for the treatment of PAH. The aim of this study was to identify the most useful parameter that correlates with hemodynamics and predicts clinical outcomes in PAH.ResultsMost of the clinical and echocardiographic RV parameters were significantly correlated with pulmonary vascular resistance (PVR) as well as mean pulmonary arterial pressure (mPAP). Among these, three dimensional right ventricular ejection fraction (3DRVEF) showed the strongest hemodynamic correlation, followed by 6-minute walk distance. Receiver operating characteristic analysis of association with cardiac events including death, hospitalization, and intervention revealed a greater area under the curve for 3DRVEF than for mPAP (0.78 vs. 0.74). Kaplan-Meier analysis showed that patients with 3DRVEF less than 38% had significantly shorter event-free survival than those with greater than 38% (P = 0.0007). Finally, the Cox proportional hazards analysis revealed that 3DRVEF, but not mPAP, was an independent predictor of clinical events in PAH.Materials and MethodsEighty-six consecutive patients were enrolled in this study. RV hemodynamic parameters were measured by right heart catheterization (RHC). RV function was assessed using two-dimensional speckle-tracking echocardiography and three-dimensional transthoracic echocardiography (3DTTE) to evaluate RV free wall global strain (RVFS) and RVEF.ConclusionsRVEF measured by 3DTTE could be a useful parameter for noninvasively assessing RV hemodynamics and predicting the clinical outcomes in PAH patients.

Dominance of free wall radial motion in global right ventricular function of heart transplant recipients

“…In primary pulmonary hypertension patients, a close relationship can be observed between pulmonary vascular resistance and various RV functional parameters. 27 Moreover, these patients show maintained longitudinal RV shortening for a long time and the loss of radial function is suggested to be an early marker of the disease. 28,29 These findings are not concordant with what is seen in HTX patients.…”

“…Therefore, we should be cautious highlighting only pulmonary pressures regarding RV functional shift on a long‐term follow‐up. In primary pulmonary hypertension patients, a close relationship can be observed between pulmonary vascular resistance and various RV functional parameters . Moreover, these patients show maintained longitudinal RV shortening for a long time and the loss of radial function is suggested to be an early marker of the disease .…”

State-of-the-Art Review: Echocardiography in Pulmonary Hypertension

“…Normative data are available for this methodology and the normal right ventricular ejection fraction using these methods is !45% [8]. Recent data reported the three-dimensional right ventricular ejection fraction had a stronger correlation with directly mean pulmonary artery pressure than traditional measured of right ventricular systolic function [14].…”

“…Newer echocardiographic techniques have also been shown to predict poor outcome in pulmonary hypertension including reduced right ventricular longitudinal strain [15][16][17][18][19], poor global right ventricular area strain [20] and reduced three-dimensional right ventricular ejection fraction or greater end-systolic indexed volumes [14,20,47,48].…”

Evaluation and Visualization of the Right Ventricle Using Three-Dimensional Echocardiography

“…This may suggest that RVEF is significantly correlated with PH. Murata et al [1] reported that RVEF measured by 3D echo could help to noninvasively predict the clinical outcomes of PH. Thus, 3D echo data might be useful for evaluating patients' cardiac condition and choosing treatment.…”